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American Academy of Pediatrics
Visual Diagnosis

Scalp Swelling and Spinal Dimpling in Two Term Infants

Aaron M. Schuh and Jennifer E. Berkowski
NeoReviews June 2019, 20 (6) e355-e359; DOI: https://doi.org/10.1542/neo.20-6-e355
Aaron M. Schuh
*Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI
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Jennifer E. Berkowski
*Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI
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Case 1

A female neonate is noted to have a painless scalp swelling on routine newborn examination.

Prenatal and Birth Histories

  • Born to a 36-year-old, gravida 1, para 2-0-0-2 woman

  • Prenatal course complicated by dichorionic-diamniotic twin pregnancy

  • Estimated gestational age: 37 weeks

  • Scheduled cesarean section for breech presentation, delivery without vacuum or instrumentation of head

  • Prenatal laboratory values unremarkable

  • Apgar scores: 7 and 8 at 1 and 5 minutes, respectively

Presentation

Routine newborn examination on the 1st day after birth was notable for a focal 1.2-cm swelling adjacent to the sagittal suture midway between the anterior and posterior fontanelles (Fig 1).

Figure 1.

Cystic scalp lesion anterior to the posterior fontanelle.

Progression

Vital Signs

  • Blood pressure: 64/43 mm Hg

  • Pulse: 116 beats/min

  • Temperature: 36.8°C (98.2°F)

  • Respiratory rate: 40 breaths/min

  • Oxygen saturation: 100% (in room air)

Physical Examination (Day 1)

  • Birthweight: 2.81 kg (17th percentile), length: 50 cm (74th percentile), head circumference 32 cm (5th percentile)

  • General: Alert and in no distress

  • Head: Normocephalic, atraumatic, anterior fontanelle open, soft, flat. A focal 1.2-cm cystic swelling immediately adjacent to the sagittal suture midway between the anterior and posterior fontanelles was found during routine palpation of the cranial suture lines. The swelling felt cystic and was fluctuant, but did not extinguish with pressure. The adjacent parietal bones were overlapping along the suture with the bone plate contralateral to the swelling being the more superior of the 2 bone plates. No defect was palpated in the bone plates. The overlying skin was normal without thinning, color change, tenderness, or pitting. Hair distribution was normal.

  • Eyes: Pupils equal, round, reactive to light, red reflex present bilaterally

  • Mouth: Intact palate

  • Neck: Supple without lymphadenopathy or thyromegaly

  • Lungs: Clear to auscultation bilaterally

  • Heart: Regular rate and rhythm, normal S1, S2, no murmur

  • Abdomen: Soft, nontender, nondistended, no masses, no hepatosplenomegaly, normoactive bowel sounds

  • Genitourinary: Normal female, patent anus

  • Back: Spine straight and …

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NeoReviews
Vol. 20, Issue 6
1 Jun 2019
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Scalp Swelling and Spinal Dimpling in Two Term Infants
Aaron M. Schuh, Jennifer E. Berkowski
NeoReviews Jun 2019, 20 (6) e355-e359; DOI: 10.1542/neo.20-6-e355

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Scalp Swelling and Spinal Dimpling in Two Term Infants
Aaron M. Schuh, Jennifer E. Berkowski
NeoReviews Jun 2019, 20 (6) e355-e359; DOI: 10.1542/neo.20-6-e355
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More in this TOC Section

  • Severe Intrauterine Growth Restriction, Thrombocytopenia, and Direct Hyperbilirubinemia in a 26-week Premature Infant
  • An Unexpected Brain Lesion in a 2-month-old Infant
  • A Large Tortuous Umbilical Cord with Superficial Abdominal Wall Varicose Veins in a Newborn
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